INDICATIONS AND USAGE
Hypertension
MICARDIS is indicated for the treatment of
hypertension, to lower blood pressure. Lowering blood pressure reduces
the risk of fatal and nonfatal cardiovascular events, primarily strokes
and myocardial infarctions. These benefits have been seen in controlled
trials of antihypertensive drugs from a wide variety of pharmacologic
classes including the class to which this drug principally belongs.
Control of high blood pressure should be
part of comprehensive cardiovascular risk management, including, as
appropriate, lipid control, diabetes management, antithrombotic therapy,
smoking cessation, exercise, and limited sodium intake. Many patients
will require more than one drug to achieve blood pressure goals. For
specific advice on goals and management, see published guidelines,
such as those of the National High Blood Pressure Education Program’s
Joint National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC).
Numerous antihypertensive drugs, from a variety of
pharmacologic classes and with different mechanisms of action, have
been shown in randomized controlled trials to reduce cardiovascular
morbidity and mortality, and it can be concluded that it is blood
pressure reduction, and not some other pharmacologic property of the
drugs, that is largely responsible for those benefits. The largest
and most consistent cardiovascular outcome benefit has been a reduction
in the risk of stroke, but reductions in myocardial infarction and
cardiovascular mortality also have been seen regularly.
Elevated systolic or diastolic pressure
causes increased cardiovascular risk, and the absolute risk increase
per mmHg is greater at higher blood pressures, so that even modest
reductions of severe hypertension can provide substantial benefit.
Relative risk reduction from blood pressure reduction is similar across
populations with varying absolute risk, so the absolute benefit is
greater in patients who are at higher risk independent of their hypertension
(for example, patients with diabetes or hyperlipidemia), and such
patients would be expected to benefit from more aggressive treatment
to a lower blood pressure goal.
Some antihypertensive drugs have smaller blood pressure effects (as
monotherapy) in black patients, and many antihypertensive drugs have
additional approved indications and effects (e.g., on angina, heart
failure, or diabetic kidney disease). These considerations may guide
selection of therapy.
It may
be used alone or in combination with other antihypertensive agents
[see Clinical Studies ]
.
CardiovascularRisk Reduction
MICARDIS
is indicated for reduction of the risk of myocardial infarction, stroke,
or death from cardiovascular causes in patients 55 years of age or
older at high risk of developing major cardiovascular events who are
unable to take ACE inhibitors.
High risk for cardiovascular events can be evidenced by a history
of coronary artery disease, peripheral arterial disease, stroke, transient
ischemic attack, or high-risk diabetes (insulin-dependent or non-insulin
dependent) with evidence of end-organ damage
[see
Clinical Studies ]
. MICARDIS can be used in addition to other needed treatment
(such as antihypertensive, antiplatelet or lipid-lowering therapy)
[see Clinical Studies ]
.
Studies
of telmisartan in this setting do not exclude the possibility that
telmisartan may not preserve a meaningful fraction of the effect of
the ACE inhibitor to which it was compared. Consider using the ACE
inhibitor first, and, if it is stopped for cough only, consider re-trying
the ACE inhibitor after the cough resolves.
Use of telmisartan with an ACE inhibitor is not recommended
[see Warnings and Precautions ]
.
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